Program Manager, Claims Job at Randstad (Toronto)

Technical Program Manager - Ecosystem Data Operations

The Technical Program Manager plays a pivotal role in ensuring the highest quali...

Location

United States , Seattle

Salary:

124000.00 - 150000.00 USD / Year

Truveta

Expiration Date

Until further notice

Requirements

5+ years technical program/project management delivering cloud data services or platform integrations
3–5+ years working with healthcare data (EHR, clinical warehouses, or claims) and familiarity with clinical workflows
Strong program discipline: ADO / work-back planning, risk management, stakeholder communication, and change control
Comfortable in product/ops environments: translating product requests into ops changes and vice-versa
Experience in a startup environment, especially with the ability to be comfortable (and thrive) with uncertainty and operate independently
Excellent verbal and written communication
ability to run technical working sessions and executive updates

Job Responsibility

Lead data onboarding engagements
Serve as the external facing technical partner
Own operations & continuous improvement
Communication & visibility
Be the “voice of the member” within Truveta
The team, the team, the team

What we offer

Comprehensive benefits with strong medical, dental and vision insurance plans
401K plan
Professional development & training opportunities for continuous learning
Work/life autonomy via flexible work hours and flexible paid time off
Generous parental leave
Regular team activities (virtual and in-person)
Additional compensation such as incentive pay and stock options

Fulltime

Benefits Program Manager

Join our expanding People team as Benefits Program Manager and champion a world-...

Location

United States , Los Angeles; Chicago; New York City

Salary:

91000.00 - 137000.00 USD / Year

FloQast

Expiration Date

Until further notice

Requirements

4+ years of successful proven experience as a US Benefits Manager or similar position
Strong knowledge of benefits and healthcare in the US is required
Strong understanding and practical application of US benefits rules and regulations
Detail-oriented with strong analytical, problem-solving and decision-making skills
Strong analytical skills with the ability to collect and analyze data using basic and intermediate analysis techniques in MS Excel / Google Sheets (sort/filter, vlookups, index/match, pivot tables, etc.)
Excellent organizational skills with the ability to work independently and effectively with minimal supervision
Strong communication skills to successfully interact with various levels of the organization such as Individual Contributors, Managers, Finance leaders and more
Strong project management skills to drive tasks and projects to completion
Practical experience with UKG Pro or similar benefits / HRIS platforms
Experience with GSuite, Slack, and Zoom applications or other similar collaboration tools is a must

Job Responsibility

Manage US benefits programs end-to-end: daily administration, vendor management and procurement, data cleanliness, QLEs, and employee support
Manage relationships with external US benefits vendors and service providers to ensure high-quality service and cost-effective solutions
Manage and support US Leave of Absence programs with the wider People team ensuring efficiency, consistent experience for employees, and compliance
Audit US benefits data and billing to ensure accuracy for enrollments, invoices, QLEs, etc.
Work with Payroll and Accounting to audit and ensure accurate US employee benefit deductions, contributions, funding and payments
Assist in developing and leading education and communication strategies to enable US employees to comprehend and successfully utilize our benefit programs. Promote employee utilization of the resources available to them for benefits assistance, education, and claims support
Support the monitoring and reporting on US benefits plan performance, utilization, and employee satisfaction to identify trends, cost drivers, and areas for improvement
Oversee compliance with all federal and state regulations governing health and welfare plans, including COBRA
Provide support for global benefits programs as needed, collaborating with the Senior Total Rewards Analyst
Assist with the creation and maintenance of US benefits program documentation such as descriptions, workflows, policies, guidelines, etc.

What we offer

Medical
Dental
Vision
Family Forming benefits
Life & Disability Insurance
Unlimited Vacation

Fulltime

Program Manager

The Program Manager will be responsible for organizing and managing databases re...

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proficiency in Aderant
Proficiency in Adobe Acrobat
Experience with Automated City Register Information System (ACRIS)
Experience with Case Management Software
Knowledge of CompuLaw
Understanding of Billing Functions
Strong briefing skills
Proficiency in Calendar Management
Experience in Claim Administration
Excellent Communication skills

Job Responsibility

Organize and manage databases of various legal aid wildfire relief efforts
Ensure accessibility of database information
Gather and organize resources related to wildfire relief efforts
Develop ways to disseminate updates and information
Assist in coordinating and keeping records of Southern California wildfire relief meetings
Regularly participate in meetings with community partners
Brief the Pro Bono Team and agency staff on key community initiatives
Collaborate with staff from other legal aid agencies

What we offer

medical
vision
dental
life and disability insurance
eligibility to enroll in 401(k) plan

Fulltime

Claims Adjuster

A growing company in Warminster is seeking a Claims Adjuster for a long term eng...

Location

United States , Warminster

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of experience in a similar role as an Admissions Specialist
Proficiency in using ADP - Financial Services software
Experience with Avaya CMS
Knowledge and understanding of Banner Ads
Familiarity with CMS Platform
Ability to use various computer programs
Experience in answering inbound calls
Understanding and execution of benefit functions
Ability to perform billing functions efficiently
Experience in claim administration

Job Responsibility

Investigate, analyze, and resolve claims related to vehicle damage, customer property, and medium-to-high exposure third-party bodily injury
Assess claim value and liability to recommend settlements through denial, compromise, or payment
Ensure timely and accurate investigations, leveraging advanced techniques and knowledge of the insurance process
Apply specialized knowledge and techniques for understanding risks, insurance products, and claims investigation processes
Collaborate with other departments and stakeholders to understand risks under management and manage products offered
Handle complex and high-stakes claims requiring sound judgment and thorough analysis
Communicate effectively with claimants, legal representatives, and stakeholders to manage expectations and maintain professionalism
Address and resolve disputes or escalated issues on complex claims with diplomacy and tact
Explain policy details, coverage limitations, and claim decision rationale clearly and accurately
Ensure the integrity and security of proprietary information throughout claims handling

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

New

Medical Appeals/Grievance Specialist II - Registered Nurse

Responsible for utilizing clinical acumen and managed care expertise related to ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

1 year experience in clinical and health insurance or other healthcare related field
3 years experience in clinical and health insurance or other healthcare related field AND 1 year Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
5 years experience in clinical and health insurance or other healthcare related field AND 2 years Managed care experience with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
8 years experience in clinical and health insurance or other healthcare related field AND 3 years above satisfactory job performance in the managed care environment with a focus in Utilization Management (UM), Prior Authorization (PA), Claims, Case Management and/or Medical Appeals and Grievance (MAG)
Associate’s Degree in a healthcare field of study or Nursing Diploma
Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) or a compact state as a Registered Nurse (RN), a Physical Therapist (PT) or a Licensed Master Social Worker LMSW.
Intermediate PC proficiency
Intermediate skill using office equipment, including copiers, fax machines, scanner and telephones
Maintain confidentiality and privacy
Advanced clinical knowledge

Job Responsibility

Perform in-depth analysis, clinical review and resolution of provider appeals/inquiries, corrected claims and subscriber reconsiderations, member appeals, corrected claims and provider grievances for all lines of business
Identify, research, process, resolve and respond to customer inquiries primarily through written / verbal communication.
Respond to a diverse and high volume of health insurance appeal related correspondence on a daily basis.
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of appeal, grievance and reconsideration requests.
Maintain complete and accurate records per department policy.
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
Demonstrate ability to apply plan policies and procedures effectively.
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
Attend staff and interdepartmental meetings.
Participate in continuing education and current developments in the fields of medicine and managed care.

Fulltime

Assistant Risk Manager

Our client located in Downtown, Houston, TX is seeking a dedicated and experienc...

Location

United States , Houston, TX

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

A minimum of 5 years of experience in risk management roles (National or International companies preferred)
Proven experience managing insurance programs, specifically fleet insurance
At least 5 years of experience in a management or leadership capacity
Strong knowledge of OSHA regulations and the ability to obtain OSHA 30 Certification (if not already certified)
Familiarity with workers' compensation programs and procedures
Exceptional reporting and communication skills
A detail-oriented and proactive mindset with a strong ability to manage multiple projects
Risk management or insurance-related certifications (e.g., ARM, CRM, CIC)
Experience working with fleet operations in the transportation or logistics industries
Proficiency in risk management software or tools

Job Responsibility

Assist in developing, implementing, and maintaining risk management strategies and policies
Oversee insurance programs, including policy renewals, claims management, and coverage analysis
Collaborate with fleet managers to ensure proper insurance coverage and risk controls for all vehicular assets
Ensure OSHA compliance and workplace safety protocols, drive participation in OSHA certification efforts
Manage workers’ compensation claims and program administration
Compile, analyze, and deliver comprehensive risk management reports to senior leadership
Lead, mentor, and oversee a risk management team to achieve organizational objectives

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Senior Manager, ACAS Provider Contract Testing

Senior Manager role in the Testing Center of Excellence (TCOE) requiring strateg...

Location

United States , Work at Home

Salary:

82940.00 - 182549.00 USD / Year

CVS Health

Expiration Date

December 31, 2025

Requirements

5+ years of experience managing quality assurance or testing teams
5+ years in commercial Aetna Claim Adjudication System (ACAS) contract testing, claims adjudication systems, or related functions
5+ years proven track record in governance, stakeholder management, and escalation handling
5+ years strong program and project management expertise, including integrated planning and risk management
Bachelor's degree required or equivalent work experience
Strong work ethic, self-starter, ability to thrive in dynamic, collaborative environment

Job Responsibility

Lead the Commercial Contract Testing team, ensuring alignment with organizational goals and quality standards
Establish and maintain governance frameworks for testing processes, ensuring adherence to regulatory and contractual requirements
Serve as the primary point of contact for business and IT stakeholders, providing clear updates on testing progress, risks, and mitigation strategies
Proactively identify and resolve issues, managing escalations effectively to minimize impact on delivery timelines
Oversee end-to-end testing activities for commercial contracts, ensuring accuracy, completeness, and timely delivery
Develop and present comprehensive quality and performance reports to senior leadership, including actionable insights and recommendations
Mentor and coach team members, fostering a culture of accountability, collaboration, and continuous improvement
Partner with IT to enhance testing automation capabilities and adopt innovative approaches to improve efficiency and accuracy

What we offer

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
No-cost wellness screenings
Tobacco cessation and weight management programs
Confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources

Fulltime

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New

Director, Payment Integrity

The Director, Payment Integrity provides strategic leadership and oversight for ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

10 years of experience in Payment Integrity, Special Investigation Unit, or healthcare anti-fraud
7+ years of experience in management role
2+ years of experience in Vendor Partner Oversight
contracting and vendor management of external payment vendors and/or audit firms
Demonstrated success in developing and executing enterprise-wide strategies
Bachelor's Degree in business, statistics, healthcare administration or related field of study
Intermediate PC proficiency
Intermediate skill in use of office equipment
Basic skill in word processing and presentation software
Intermediate proficiency in spreadsheet, statistical analysis, query / data mining, and business intelligence software

Job Responsibility

Develop and execute enterprise-wide Payment Integrity strategy aligned with organizational objectives and cost of care targets
Lead the design, implementation, and continuous improvement of payment integrity programs, including pre- and post-payment audits, recovery, and investigative functions
Establish and maintain governance structures, including cross-functional committees, to oversee payment integrity controls and policy development
Representing the organization in internal and external forums, collaborating with industry peers, regulatory bodies, and vendor partners to share best practices and drive innovation
Stay abreast of emerging trends, technologies, and regulatory shifts in the healthcare payment integrity space
Oversee day-to-day operations, ensuring timely, accurate, and compliant claims payment and recovery activities
Direct vendor management, including contracting, performance oversight, and strategic partnerships for payment integrity solutions
Drive automation and technology adoption to enhance payment integrity processes and reporting capabilities
Lead cost-benefit analyses to determine optimal resource allocation (internal vs. outsourced functions)
Set and monitor KPIs, SMART goals, and financial targets for payment integrity initiatives

Fulltime

Program Manager, Claims

Randstad

Location:
Canada , Toronto

Category:
IT - Administration

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Nice to have:

Additional Information:

Job Posted:
December 28, 2025

Expiration:
February 19, 2026

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